Discussion in 'Parents of Children with Type 1' started by MomofSweetOne, Apr 6, 2012.
Has anyone been able to get MySentry covered by BCBS? If so, at what amounts?
I would also like to know
I also want to know this info .........and I guess I'm about to find out! We purchased a MySentry along with our pump and so now I am about to send in the paper work to see if it gets approved with BCBS! We're praying it does!
I talked with our MM rep on Friday and he said that no insurance company that he is aware of has covered it yet. Please let us know if you get it covered. It has to happen sometime.
I do know of several insurance companies that have covered the My Sentry. BCBS is not one of them
Do you know which insurance companies have approved the MySentry? This would maybe aid with BCBS. Thanks,
does anyone know if Tenncare will pay for the mysentry?
Was able to get MySentry fully covered by BCBS! Just got it delivered in the last week!
More info please...can you share, what you had to do...would live knowledge n how you did it...
I'd like to know about the BCBS coverage too!
What state, and is your BCBS a PPO or HMO?
Did you have to pay OOP and apply for reimbursement or did it get processed like other items?
I have gotten quite a few questions so I will try to cover them all.
1. We live in Illinois and our insurance is BCBS Advantage and is HMO.
2. We worked with our endo's office and they did the request and prescription - I am not sure if they used the term "medically necessary"; however we have had Morgan on a sensor for over a year and shows how she fluctuates at night and has had many night lows. Surprisingly, we were able to get the referral ok'd pretty quickly without any appeals. The main problem seemed to be billing and how to bill for this new item. Then there was no way for BCBS to bill Medtronic because there was not an item number. I went round and round with BCBS and Advocate Physicians Group (who usually supply us with her pump and cgm supplies), literally calling them every few days. Medtronic kept telling me that I would have to pay upfront and then ask insurance for reimbursement. Advocate Physicians Group kept telling me not to pay and they would keep working on it - they kept saying if BCBS doesn't have a billing number then I would have the same problems trying to get reimbursed without an item number. Basically, it was approved for months and they could not figure out the billing. Medtronic ended up shipping the MySentry directly to us and they have said that it is being done by considering us a one time contractor but directly billing BCBS. I am not sure exactly how this worked but I called BCBS and Advocate, and sometimes Medtronic every few days for the 90 days that our referral was good for - they finally figured out how to bill it on the 89th day. I am still not sure how we were so lucky, but I was an advocate for Morgan and kept calling, and calling, and calling.
Hopefully I answered most of the questions, if there are any more please send my way. Good Luck!
Yay! We have BCBS HMO of Illinois!
Just so I'm clear, did you submit that entire package Medtronic gives you, or did your doctor just submit a prescription and a letter of medical necessity?
I did turn in the entire package that Medtronic gave us (to the doctor) and I assumed they submitted that with the request.
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